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Metastatic Melanoma to the Pituitary Gland

Published online by Cambridge University Press:  02 December 2014

Ian E. McCutcheon ,
Steven G. Waguespack ,
Gregory N. Fuller  and
William T. Couldwell
Ian E. McCutcheon
Affiliation:
Departments of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
Steven G. Waguespack
Affiliation:
Departments of Endocrine Neoplasia and Hormonal Disorders, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
Gregory N. Fuller
Affiliation:
Departments of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
William T. Couldwell
Affiliation:
Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Abstract

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Background:

Metastasis to the pituitary gland is unusual, and occurs most often in patients with carcinomas of the breast or lung. Despite its propensity for spread to the brain, metastatic melanoma has rarely been described within the sella.

Methods:

We report two cases of malignant melanoma pathologically confirmed within the pituitary, both metastatic from a primary site on the chest wall. In each patient, transsphenoidal resection of the tumor was incomplete and each received local radiotherapy after surgery.

Results:

One patient recurred quickly and developed brain metastasis as well. He died four months after resection of the pituitary metastasis, but the second patient survived six months without recurrence. As intrasellar metastasis portends widespread systemic disease and may be synchronous with parenchymal brain metastasis, survival in such patients is limited regardless of adjunctive therapy.

Conclusions:

Such cases are likely to arise more commonly in future due to the increasing incidence of melanoma. Identifying them by imaging alone is difficult due to inconsistent signal characteristics on MRI (as shown by these cases) and the confusion introduced by any associated intratumoral hemorrhage.

Résumé:

RÉSUMÉ:

Métastase pituitaire d'un mélanome. Les métastases à l'hypophyse sont rares et surviennent la plupart du temps chez des patients porteurs d'un cancer du sein ou du poumon. Bien que le mélanome ait tendance à métastaser au cerveau, une métastase à la selle turcique a rarement été décrite. Méthodes : Nous rapportons deux observations cliniques de mélanome malin dans l'hypophyse, confirmés en anatomopathologie. La tumeur primitive dans les deux cas était située sur le thorax. La résection transsphénoïle a été incomplète chez les deux patients et ils ont reçu de la radiothérapie locale après la chirurgie. Résultats : Un patient a eu une récidive peu de temps après et il a présenté également des métastases cérébrales. Il est décédé quatre mois après la résection de la métastase pituitaire. Le deuxième patient a survécu six mois sans récidive. Étant donné qu'une métastase intrasellaire laisse présager une maladie systémique disséminée et peut coïider avec des métastases cérébrales parenchymateuses, la survie de ces patients est limitée, quel que soit le traitement d'appoint. Conclusions : Comme l'incidence du mélanome augmente, ces cas seront de plus en plus fréquents. Il est difficile de les identifier seulement par l'imagerie à cause de caractéristiques variables du signal à l'IRM, ce qui était le cas chez nos patients, et de l'association possible d'une hémorragie intratumorale, ce qui introduit un facteur de confusion.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 34 , Issue 3 , August 2007 , pp. 322 - 327
Copyright
Copyright © The Canadian Journal of Neurological 2007

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